胸廓内动脉参与肝脏肿瘤供血的影像表现与介入治疗(附6例报告)

Imaging Findings and Interventional Management of Internal Thoracic Artery Supply to Hepatic Tumors

目的：观察胸廓内动脉（ＩＴＡ）参与肝脏肿瘤供血的影像表现和介入治疗效果。材料与方法：４年间发现ＩＴＡ参与肝癌供血６例，经血管造影证实，男性５例，女１例，年龄３６～５２岁，均有超声波及ＣＴ检查资料，３例曾做ＭＲＩ检查。既往均曾行肝动脉化疗栓塞（２～８次）。ＩＴＡ造影用５Ｆ眼镜蛇形导管，对向肿瘤供血的ＩＴＡ分支行栓塞治疗，２例用同轴微导管。结果：肝癌均为巨块型，位于肝脏前部、包膜下，伴有局部肝包膜侵犯３例，６例ＣＴ片均显示右侧胸廓内血管影增粗。ＩＴＡ造影显示均为右侧ＩＴＡ分支参与肿瘤供血，栓塞治疗均成功。术后ＣＴ复查显示肿瘤缩小或／和瘤区碘油积聚增多，末次治疗前αＦＰ＞２００μｇ／Ｌ３例，术后逐渐降至正常。ＩＴＡ栓塞后并发胸／腹壁皮肤损伤３例。结论：位于肝脏前部、包膜下的肿瘤可接受ＩＴＡ供血；在经ＩＴＡ途径行栓塞治疗时应警惕皮肤损伤并发症。

Objective: To observe imaging features and interventional therapeutic effectiveness of internal thoracic artery (ITA) supply to hepatic tumors.Materials and Methods:Over a 4year period, 6 patients with ITA supply to hepatocellular carcinomas was identified by angiogrphy. 5 men and 1 woman ranged in age from 36 to 52 years. All patients had abdominal ultrasound examination and CT scan, 3 had MR imaging. Transcatheter hepatic artery chemoembolization was done in all 6 patients (2～8 times). ITA arteriography was performed with a 5 french cobrashaped catheter. All arteries supplying to tumor were embolized using lipiodol with anticancer drug. Coaxial microcatheter was used in 2 cases.Results:All lesions were massive type and located in the anterior and subcapsular of the liver. Focal hepatic capsule invasion was found in 3 cases. Enlargement of ITAs was presented on CT in all 6 patients. ITA catheterization revealed that these lesions drew blood supply from right ITA in the six patients. All the tumor supply were successfully embolized. Lesions diminished in size and/or increased lipiodol retention were found on followup CT. 3 patients had an αFP level over 200μg/L prior to ITAs embolization, and returned to normal after embolization. Focal cutaneous damage of the chest and abdominal wall was presented in 3 patients after the treatment.Conclusion: Tumors located anteriorly and superficially in the liver may recruit blood supply through ITA collaterals. Cutaneous damage should be cautious during ITAs embolization.